Re: Hospital violations by making you wait in the hallway...

[Guest guest]

Your hospital is violating EMTALA and also the common law of torts. It is

exposing itself to massive fines and damages through its actions.

You ask for the actual statutes being violated. I really don't have time to

research it, but just do a Google.com search for " EMTALA " and you'll find a

plethora of information.

You have an absolute duty to report the hospital to CMS as an EMTALA

violator. Do that through their hotline, which you can access easily from the

Internet. You can do so anonymously, but of course, in order for CMS to

understand

the violation, they'll need patient name, time of incident, and so forth,

which will identify you. They promise to maintain secrecy, but if you believe

that, I've got some prime lakefront property here in Shackelford County that

I'd like to sell you.

The fines are $50,000 per incident, and a call to CMS will bring on an

investigation that they will not like.

Now, of course, you may have to deal with your own service, which may

determine that it doesn't want to stir the pot. If you work for a private

service,

that's probably what will happen. And even some public services will cowtow

to the hospital. It all depends upon how strong your management is for

patient rights.

Another course of action is a " leak " to a member of the press. That can be

interesting.

The individual paramedic always has to weigh the costs of obeying the law

with the costs of being fired by an unethical employer for following the law.

I

can't help you there.

Unfortunately, whistleblowers usually get the short end of the stick. So

look before you leap. But protect yourself through extensive documentation,

and whenever possible, record conversations with those who cause you problems.

In Texas, it is perfectly legal to record a conversation with another person

as long as you are a party to the conversation. A cheap pocket recorder, or

many models of cellular phones afford that feature. Get people on record.

When you've got them on record, in their own words, it's magic how their

administrators will come around to your point of view.

Also, when a hospital staff member tells you that, you should immediately

contact a supervisor with your service and let her/him know what is going on.

These problems really should be worked out between your service and the

hospital. But you're entirely justified in reporting the hospital for an

EMTALA

violation.

Gene G.

> Just recently, a hospital made me wait in the hallway with my 'low

> priority' patient until they could find a room for him. Meanwhile,

> many other calls are dropping and I need to get in service to cover

> the city. The ER personnel stated that the " patient is not our

> responsibility until we take report from you. You have to stay with

> that patient to monitor him. " What kind of violation is this in

> regards to EMTALA, RAC, or GETAC? Where can I find the literature to

> back this to prevent me from just quoting 'hearsay'? I have a copy of a

> March 2002 letter from the " Center for Medicare & Medicaid Services " . 

> I believe it contains too many 'coulds' and 'may's' to deliver any

> definitiveness to hospitals.  Do you know the actual statutes being

> violated?  thnx. FF/P.

>

>

>

>

>

>

>

>

>

>

[Guest guest]

I concur with Dudley. He states the right approach, and he states it much

better than I did.

This is a serious problem and must be addressed. By not addressing it, we

leave ourselves open to criticism and, ultimately, liability for damages which

may extend to both EMS and the hospital.

Gene G.

> Mark,

>

> This could be viewed as an EMTALA violation.  The letter you have clearly

> states the CMS interprets holding EMS crews without the hospital evaluating

the

> patient is clearly not what the statute had in mind and would be viewed as a

> violation. 

>

> That being said, we are between a rock and a hard place.  Do we notify CMS

> everytime it happens?  How often are we being asked to wait?  How long are we

> being asked to wait?  Has the administration of the EMS agency had any

> conversations with the hospital ED administration outside of an actual hold

> incident? 

>

> What happens if we leave the patient there, putting them in a wheel chair? 

> Probably nothing unless the patient suffers harm (falls out, suffers a

> complication and no one catches it, etc) then both the EMS agency and the

hospital

> will be spending some time talking with their attorneys. 

>

> Some agencies (in Arizona I believe) were leaving patients on backboards on

> the floor when hospitals kept them backed up for extended periods and

> extended numbers of ambulances.  A system I worked for considered leaving

spare

> stretchers in the ED so that we could put our ambulance back in service

leaving

> the patient on our stretcher in the hall...like a hall bed.  BUT, didn't work

> because our risk manager felt leaving patients on our stretchers would keep

> us liable if the stretcher failed or hospital personnel were injured trying to

> use it.

>

> Some agencies have used supervisors or extra personnel (like we have those

> hanging around)  to sit with the patients in the ED and let the crew go back

> in service...again a cost to EMS that we shouldn't have to bear.

>

> I would go back to my usual reserve....if someone from your agency has not

> sat down with the hospital (or hospitals) reps then I would start there

> first.  There is a  good chance that those who are responsible for things like

> EMTALA enforcement/compliance and inter-agency relations may not know that you

> are being held in the ED.  Start there and then, if it is multiple hospitals

> doing it, take that letter you have to your next RAC meeting and " refresh "

> everyone's memory as to how to properly accept EMS patients when they arrive

at

> the door.

>

> Happy 4th of July!!!!

>

> Dudley

>

> Hospital violations by making you wait in the

> hallway...

>

>

> Just recently, a hospital made me wait in the hallway with my 'low

> priority' patient until they could find a room for him. Meanwhile,

> many other calls are dropping and I need to get in service to cover

> the city. The ER personnel stated that the " patient is not our

> responsibilty until we take report from you. You have to stay with

> that patient to monitor him. " What kind of violation is this in

> regards to EMTALA, RAC, or GETAC? Where can I find the literature to

> back this to prevent me from just quoting 'hearsay'? I have a copy of a

> March 2002 letter from the " Center for Medicare & Medicaid Services " . 

> I believe it contains too many 'coulds' and 'may's' to deliver any

> definitiveness to hospitals.  Do you know the actual statutes being

> violated?  thnx. FF/P.

>

>

>

>

>

>

>

>

>

>

[Guest guest]

I concur with Dudley. He states the right approach, and he states it much

better than I did.

This is a serious problem and must be addressed. By not addressing it, we

leave ourselves open to criticism and, ultimately, liability for damages which

may extend to both EMS and the hospital.

Gene G.

> Mark,

>

> This could be viewed as an EMTALA violation.  The letter you have clearly

> states the CMS interprets holding EMS crews without the hospital evaluating

the

> patient is clearly not what the statute had in mind and would be viewed as a

> violation. 

>

> That being said, we are between a rock and a hard place.  Do we notify CMS

> everytime it happens?  How often are we being asked to wait?  How long are we

> being asked to wait?  Has the administration of the EMS agency had any

> conversations with the hospital ED administration outside of an actual hold

> incident? 

>

> What happens if we leave the patient there, putting them in a wheel chair? 

> Probably nothing unless the patient suffers harm (falls out, suffers a

> complication and no one catches it, etc) then both the EMS agency and the

hospital

> will be spending some time talking with their attorneys. 

>

> Some agencies (in Arizona I believe) were leaving patients on backboards on

> the floor when hospitals kept them backed up for extended periods and

> extended numbers of ambulances.  A system I worked for considered leaving

spare

> stretchers in the ED so that we could put our ambulance back in service

leaving

> the patient on our stretcher in the hall...like a hall bed.  BUT, didn't work

> because our risk manager felt leaving patients on our stretchers would keep

> us liable if the stretcher failed or hospital personnel were injured trying to

> use it.

>

> Some agencies have used supervisors or extra personnel (like we have those

> hanging around)  to sit with the patients in the ED and let the crew go back

> in service...again a cost to EMS that we shouldn't have to bear.

>

> I would go back to my usual reserve....if someone from your agency has not

> sat down with the hospital (or hospitals) reps then I would start there

> first.  There is a  good chance that those who are responsible for things like

> EMTALA enforcement/compliance and inter-agency relations may not know that you

> are being held in the ED.  Start there and then, if it is multiple hospitals

> doing it, take that letter you have to your next RAC meeting and " refresh "

> everyone's memory as to how to properly accept EMS patients when they arrive

at

> the door.

>

> Happy 4th of July!!!!

>

> Dudley

>

> Hospital violations by making you wait in the

> hallway...

>

>

> Just recently, a hospital made me wait in the hallway with my 'low

> priority' patient until they could find a room for him. Meanwhile,

> many other calls are dropping and I need to get in service to cover

> the city. The ER personnel stated that the " patient is not our

> responsibilty until we take report from you. You have to stay with

> that patient to monitor him. " What kind of violation is this in

> regards to EMTALA, RAC, or GETAC? Where can I find the literature to

> back this to prevent me from just quoting 'hearsay'? I have a copy of a

> March 2002 letter from the " Center for Medicare & Medicaid Services " . 

> I believe it contains too many 'coulds' and 'may's' to deliver any

> definitiveness to hospitals.  Do you know the actual statutes being

> violated?  thnx. FF/P.

>

>

>

>

>

>

>

>

>

>

[Guest guest]

I am sure there are those who know more than I, but through recent events I have

been made aware that once the patient is on hospital property, regardless of

whether the ED has accepted him/her, that patient is the hospital's

responsibility. EMTALA. Excessive delays do constitute an EMTALA violation as I

understand it.

________________________________

From: on behalf of Mark Sastre

Sent: Mon 7/4/2005 5:39 PM

To:

Subject: Hospital violations by making you wait in the hallway...

Just recently, a hospital made me wait in the hallway with my 'low

priority' patient until they could find a room for him. Meanwhile,

many other calls are dropping and I need to get in service to cover

the city. The ER personnel stated that the " patient is not our

responsibilty until we take report from you. You have to stay with

that patient to monitor him. " What kind of violation is this in

regards to EMTALA, RAC, or GETAC? Where can I find the literature to

back this to prevent me from just quoting 'hearsay'? I have a copy of a

March 2002 letter from the " Center for Medicare & Medicaid Services " .

I believe it contains too many 'coulds' and 'may's' to deliver any

definitiveness to hospitals. Do you know the actual statutes being

violated? thnx. FF/P.

[Guest guest]

The Center for Medicare/Medicaid office in Dallas actually has a position

statement on this very issue. I will try to locate my copy and send it on.

You might want to contact them for a copy.

Lee

Hospital violations by making you wait in the

hallway...

Just recently, a hospital made me wait in the hallway with my 'low

priority' patient until they could find a room for him. Meanwhile,

many other calls are dropping and I need to get in service to cover

the city. The ER personnel stated that the " patient is not our

responsibilty until we take report from you. You have to stay with

that patient to monitor him. " What kind of violation is this in

regards to EMTALA, RAC, or GETAC? Where can I find the literature to

back this to prevent me from just quoting 'hearsay'? I have a copy of a

March 2002 letter from the " Center for Medicare & Medicaid Services " .

I believe it contains too many 'coulds' and 'may's' to deliver any

definitiveness to hospitals. Do you know the actual statutes being

violated? thnx. FF/P.

[Guest guest]

Mark,

This could be viewed as an EMTALA violation. The letter you have clearly states

the CMS interprets holding EMS crews without the hospital evaluating the patient

is clearly not what the statute had in mind and would be viewed as a violation.

That being said, we are between a rock and a hard place. Do we notify CMS

everytime it happens? How often are we being asked to wait? How long are we

being asked to wait? Has the administration of the EMS agency had any

conversations with the hospital ED administration outside of an actual hold

incident?

What happens if we leave the patient there, putting them in a wheel chair?

Probably nothing unless the patient suffers harm (falls out, suffers a

complication and no one catches it, etc) then both the EMS agency and the

hospital will be spending some time talking with their attorneys.

Some agencies (in Arizona I believe) were leaving patients on backboards on the

floor when hospitals kept them backed up for extended periods and extended

numbers of ambulances. A system I worked for considered leaving spare

stretchers in the ED so that we could put our ambulance back in service leaving

the patient on our stretcher in the hall...like a hall bed. BUT, didn't work

because our risk manager felt leaving patients on our stretchers would keep us

liable if the stretcher failed or hospital personnel were injured trying to use

it.

Some agencies have used supervisors or extra personnel (like we have those

hanging around) to sit with the patients in the ED and let the crew go back in

service...again a cost to EMS that we shouldn't have to bear.

I would go back to my usual reserve....if someone from your agency has not sat

down with the hospital (or hospitals) reps then I would start there first.

There is a good chance that those who are responsible for things like EMTALA

enforcement/compliance and inter-agency relations may not know that you are

being held in the ED. Start there and then, if it is multiple hospitals doing

it, take that letter you have to your next RAC meeting and " refresh " everyone's

memory as to how to properly accept EMS patients when they arrive at the door.

Happy 4th of July!!!!

Dudley

Hospital violations by making you wait in the hallway...

Just recently, a hospital made me wait in the hallway with my 'low

priority' patient until they could find a room for him. Meanwhile,

many other calls are dropping and I need to get in service to cover

the city. The ER personnel stated that the " patient is not our

responsibilty until we take report from you. You have to stay with

that patient to monitor him. " What kind of violation is this in

regards to EMTALA, RAC, or GETAC? Where can I find the literature to

back this to prevent me from just quoting 'hearsay'? I have a copy of a

March 2002 letter from the " Center for Medicare & Medicaid Services " .

I believe it contains too many 'coulds' and 'may's' to deliver any

definitiveness to hospitals. Do you know the actual statutes being

violated? thnx. FF/P.

[Guest guest]

I have never, EVER, advocated leaving a patient in a hospital hallway prior

to a face-to-face report to the receiving RN. To do that would be rank

abandonment. As a matter of fact, no patient should be left until the

receiving RN

or physician's signature is obtained on the care form.

What I have said is that once the hospital has notice that the patient is

there, EMTALA requires that a timely medical screening exam be completed, and

having the transporting medics remain with the patient does not toll the time

within which this must be done. The hospital has responsibility for the

patient

from the time s/he arrives on the premises.

We're talking about two different things. One is the hospital's duty to do

a MSE in a timely fashion and the other is patient abandonment. The medics

cannot abandon their patient, but their care is not supposed to continue in the

hospital beyond the time needed to transfer the patient in a prompt and

timely fashion to the hospital's care.

Perhaps this clarifies my position.

Gene Gandy

>      Now I may be missing something or perhaps simply unaware, but,

> it is my understanding that in order for there to be a valid transfer

> of care there must take place a face to face conversation between the

> medic and a person of same or higher level of care in the hospital.

> This serves two specific purposes. First, the relationship between

> the service's medical director and the patient must be severed.

> Transfer of care to another physician by virtue of reception by

> hospital staff will accomplish that end. By the way, according to

> JCHAO an RN must do the initial assessment and discharge assessment.

> So, that person, from everyone's perspective, should be an RN.

> Secondly, it insures that ED staff is aware not only of the patients

> presence but also of their triage category and relative disposition

> after your treatment. Unless I have misunderstood the advice given

> here, it has been suggested that the patient be left in the hallway

> without giving report to the hospital staff. Would this not place the

> medics in a position for abandonment issues? We have always taught

> that in this specific situation, as it is written in several texts,

> leaving a patient in the ED without a proper transfer of care may be

> grounds for abandonment, a lawsuit that would include not just the

> medic but the service and hospital. I'm not trying to get everyone's

> feathers ruffled here. I may just be unaware of some other laws

> pertaining to this issue that would make it OK to do this. Thanks.

>

>    

>

> > RIGHT ON, LARRY!   Good advice.

> >

> > Gene

> > In a message dated 7/4/05 23:45:19, miller@g... writes:

> >

> >

> > > You are absolutely correct.  When the patient hits the hospital

> property

> > > he/she is the responsibility of the ED.   EMTALA is very clear on

> this issue.

> > > I know from having served on the San Hospital's EMS

> Diversion Task

> > > Force for many years and having served as the recent Chairman of

> the 5

> > > Baptist hospital Ed's for many years.

> > >

> > > You are staying around because you are a nice guy and want to do

> what is

> > > best for the patient.   But I will tell you unequivocally, that by

> staying

> > > with your patient in the ED you are not helping to fix the

> problem and you

> > > are neglecting your prime objective ---- to transport patients

> and practice

> > > medicine in the streets.  Is the ED staff going to help you do

> your job?  Of

> > > course not.

> > >

> > > Sometimes it takes tough love to get necessary changes made. 

> Overcrowding

> > > in the ED is not our fault.  It is not the fault of the ED

> either, but it is

> > > the fault of the hospital system as a whole.  One EMTALA fine and

> loosing

> > > Medicare Certification will get their attention.  They have the

> resources to

> > > fix the problem. Lets help them by doing our job right, instead

> of enabling

> > > them to continue their dysfunctional operations.

> > >

> > > Best,

> > >

> > >

> > > Larry MD

> > >

> > > > I am sure there are those who know more than I, but through

> recent events

> > > I

> > > > have been made aware that once the patient is on hospital

> property,

> > > regardless

> > > > of whether the ED has accepted him/her, that patient is the

> hospital's

> > > > responsibility. EMTALA. Excessive delays do constitute an

> EMTALA violation

> > > as

> > > > I understand it.

> > > >

> > > >

>

>

>

>

>

>

[Guest guest]

In a message dated 7/5/2005 5:23:18 P.M. Central Daylight Time,

texsis74@... writes:

if a paramedic is licensed

Read some of what Gene Gandy and Dr. Bledsoe have said about the whole

concept of LP in Texas. As I understand it based on their statements NO

paramedics

are TRULY " licensed " .

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(IFW Office)

(Cell Phone)

(IFW Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

My impression is that if your patient codes in the hallway of the hospital

you do immediate lifesaving procedures while calling the hospital code.

Gene

E.(Gene) Gandy

POB 1651

Albany, TX 76430

wegandy1938@...

[Guest guest]

RNs cannot delegate triage or anything else to an LVN if it is initial care.

That is the law. LVNs can only treat patients in the ER after they have

been triaged and assigned to that patient.

Todd D.

Eastland Memeorial Hospital

EMS Manager

304 S. Daugherty

PO Box 897

Eastland, Texas 76448

ext. 408

Cell

Fax

ems@...

Re: Hospital violations by making you wait in the

hallway...

> Now I may be missing something or perhaps simply unaware, but,

> it is my understanding that in order for there to be a valid

transfer

> of care there must take place a face to face conversation between

the

> medic and a person of same or higher level of care in the hospital.

> This serves two specific purposes. First, the relationship between

> the service's medical director and the patient must be severed.

> Transfer of care to another physician by virtue of reception by

> hospital staff will accomplish that end. By the way, according to

> JCHAO an RN must do the initial assessment and discharge

assessment.

> So, that person, from everyones perspective, should be an RN.

What about emergency departments that staff LVNs? A registered nurse

could delegate the task of initial assessment to an LVN for purposes

of triage which they are more than qualified to do. From that point

of view, I would venture to say that the EMS medical directors

relationship with the patient has been severed once the LVN has

received a report from EMS personnel.

> Secondly, it insures that ED staff is aware not only of the

patients

> presence but also of their triage catagory and relative disposition

> after your treatment. Unless I have misunderstood the advice given

> here, it has been suggested that the patient be left in the hallway

> without giving report to the hospital staff. Would this not place

the

> medics in a position for abandonment issues? We have always taught

> that in this specific situation, as it is written in several texts,

> leaving a patient in the ED without a proper transfer of care may

be

> grounds for abandonment, a lawsuit that would include not just the

> medic but the service and hospital. I'm not trying to get

everyone's

> feathers ruffled here. I may just be unaware of some other laws

> pertaining to this issue that would make it OK to do this. Thanks.

>

>From what I understand of JCHAO and EMTALA, a patient who presents to

an emergency department, regardless of mode of travel taken, must

have an appropriate screening examination and/or stabilizing

treatment / transfer to a higher facility. From that point of view,

the EMS personnel jobs are done when the patient presents to the

emergency department, whether or not the nurses have been given a

report.

Alfonso R. Ochoa

[Guest guest]

Actually, delegation is the assigning of tasks to unlicensed

personnel. RNs do not " delegate " to LVNs - since they are licensed,

but instead make assignments. Since the RN is responsible for

assessing the need for professional nursing tasks (those that an RN

can do but an LVN can't) before making an assignment to an LVN or

delegating to UAP, the initial assessment by definition cannot be

assigned to anyone other than an RN (how do you know whether

assignment of the assessment is appropriate unless you've

assessed?). I know - I've seen places that bend the rules, but they

do so at risk to their license.

Jen

> > Now I may be missing something or perhaps simply unaware,

but,

> > it is my understanding that in order for there to be a valid

> transfer

> > of care there must take place a face to face conversation

between

> the

> > medic and a person of same or higher level of care in the

hospital.

> > This serves two specific purposes. First, the relationship

between

> > the service's medical director and the patient must be severed.

> > Transfer of care to another physician by virtue of reception by

> > hospital staff will accomplish that end. By the way, according

to

> > JCHAO an RN must do the initial assessment and discharge

> assessment.

> > So, that person, from everyones perspective, should be an RN.

>

> What about emergency departments that staff LVNs? A registered

nurse

> could delegate the task of initial assessment to an LVN for

purposes

> of triage which they are more than qualified to do. From that

point

> of view, I would venture to say that the EMS medical directors

> relationship with the patient has been severed once the LVN has

> received a report from EMS personnel.

>

> > Secondly, it insures that ED staff is aware not only of the

> patients

> > presence but also of their triage catagory and relative

disposition

> > after your treatment. Unless I have misunderstood the advice

given

> > here, it has been suggested that the patient be left in the

hallway

> > without giving report to the hospital staff. Would this not

place

> the

> > medics in a position for abandonment issues? We have always

taught

> > that in this specific situation, as it is written in several

texts,

> > leaving a patient in the ED without a proper transfer of care

may

> be

> > grounds for abandonment, a lawsuit that would include not just

the

> > medic but the service and hospital. I'm not trying to get

> everyone's

> > feathers ruffled here. I may just be unaware of some other laws

> > pertaining to this issue that would make it OK to do this.

Thanks.

> >

>

> From what I understand of JCHAO and EMTALA, a patient who presents

to

> an emergency department, regardless of mode of travel taken, must

> have an appropriate screening examination and/or stabilizing

> treatment / transfer to a higher facility. From that point of

view,

> the EMS personnel jobs are done when the patient presents to the

> emergency department, whether or not the nurses have been given a

> report.

>

> Alfonso R. Ochoa

[Guest guest]

Thank you, Gene. That did clarify it for me. I got the initial

impression that it was being suggested to leave the patient there to

teach the ED a lesson.

> > > RIGHT ON, LARRY!   Good advice.

> > >

> > > Gene

> > > In a message dated 7/4/05 23:45:19, miller@g... writes:

> > >

> > >

> > > > You are absolutely correct.  When the patient hits the

hospital

> > property

> > > > he/she is the responsibility of the ED.   EMTALA is very

clear on

> > this issue.

> > > > I know from having served on the San Hospital's EMS

> > Diversion Task

> > > > Force for many years and having served as the recent

Chairman of

> > the 5

> > > > Baptist hospital Ed's for many years.

> > > >

> > > > You are staying around because you are a nice guy and want

to do

> > what is

> > > > best for the patient.   But I will tell you unequivocally,

that by

> > staying

> > > > with your patient in the ED you are not helping to fix the

> > problem and you

> > > > are neglecting your prime objective ---- to transport

patients

> > and practice

> > > > medicine in the streets.  Is the ED staff going to help you

do

> > your job?  Of

> > > > course not.

> > > >

> > > > Sometimes it takes tough love to get necessary changes made. 

> > Overcrowding

> > > > in the ED is not our fault.  It is not the fault of the ED

> > either, but it is

> > > > the fault of the hospital system as a whole.  One EMTALA

fine and

> > loosing

> > > > Medicare Certification will get their attention.  They have

the

> > resources to

> > > > fix the problem. Lets help them by doing our job right,

instead

> > of enabling

> > > > them to continue their dysfunctional operations.

> > > >

> > > > Best,

> > > >

> > > >

> > > > Larry MD

> > > >

> > > > > I am sure there are those who know more than I, but through

> > recent events

> > > > I

> > > > > have been made aware that once the patient is on hospital

> > property,

> > > > regardless

> > > > > of whether the ED has accepted him/her, that patient is the

> > hospital's

> > > > > responsibility. EMTALA. Excessive delays do constitute an

> > EMTALA violation

> > > > as

> > > > > I understand it.

> > > > >

> > > > >

> >

> >

> >

> >

> >

> >

[Guest guest]

Here is some interesting reading regarding nursing regulations

pertaining to this. It's kind of interesting.

http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?

sl=R & app=9 & p_dir= & p_rloc= & p_tloc= & p_ploc= & pg=1 & p_tac= & ti=22 & pt=11 & ch=

225 & rl=9

> > > Now I may be missing something or perhaps simply unaware,

> but,

> > > it is my understanding that in order for there to be a valid

> > transfer

> > > of care there must take place a face to face conversation

> between

> > the

> > > medic and a person of same or higher level of care in the

> hospital.

> > > This serves two specific purposes. First, the relationship

> between

> > > the service's medical director and the patient must be

severed.

> > > Transfer of care to another physician by virtue of reception

by

> > > hospital staff will accomplish that end. By the way, according

> to

> > > JCHAO an RN must do the initial assessment and discharge

> > assessment.

> > > So, that person, from everyones perspective, should be an RN.

> >

> > What about emergency departments that staff LVNs? A registered

> nurse

> > could delegate the task of initial assessment to an LVN for

> purposes

> > of triage which they are more than qualified to do. From that

> point

> > of view, I would venture to say that the EMS medical directors

> > relationship with the patient has been severed once the LVN has

> > received a report from EMS personnel.

> >

> > > Secondly, it insures that ED staff is aware not only of the

> > patients

> > > presence but also of their triage catagory and relative

> disposition

> > > after your treatment. Unless I have misunderstood the advice

> given

> > > here, it has been suggested that the patient be left in the

> hallway

> > > without giving report to the hospital staff. Would this not

> place

> > the

> > > medics in a position for abandonment issues? We have always

> taught

> > > that in this specific situation, as it is written in several

> texts,

> > > leaving a patient in the ED without a proper transfer of care

> may

> > be

> > > grounds for abandonment, a lawsuit that would include not just

> the

> > > medic but the service and hospital. I'm not trying to get

> > everyone's

> > > feathers ruffled here. I may just be unaware of some other

laws

> > > pertaining to this issue that would make it OK to do this.

> Thanks.

> > >

> >

> > From what I understand of JCHAO and EMTALA, a patient who

presents

> to

> > an emergency department, regardless of mode of travel taken,

must

> > have an appropriate screening examination and/or stabilizing

> > treatment / transfer to a higher facility. From that point of

> view,

> > the EMS personnel jobs are done when the patient presents to the

> > emergency department, whether or not the nurses have been given

a

> > report.

> >

> > Alfonso R. Ochoa

[Guest guest]

Pertaining to this? How? Chapter 225 deals with " RN DELEGATION TO

UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN

INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND

PREDICTABLE CONDITIONS " . Now, if we're talking about an ER we're

not talking about stable, predictable conditions in an independent

living environment. If we're talking about the LVN situation, then

we're not talking about delegating to an unlicensed healthcare

provider. Or, did you mean a different chapter of the NPA? Maybe

the link was off, because I had to piece it back together due to its

length.

I'm not trying to be rude, just not sure what you're trying to say.

As for making people wait . . . the same rules are going to apply

whether they came in by EMS or walked through the door. The ER has

an obligation to treat to their ability - and no, triage should not

be delayed just because the patient is conveniently on an EMS

stretcher. But, if triage is backed up, are you waiting any longer

than someone coming through the door for triage? If you are, then

that's a problem. If everyone is having to wait 5-10 minutes to get

put into the system because of extreme patient numbers, then can you

take a deep breath and realize we're all on the same team, and

they're not intentionally trying to keep you imprisoned in their

hallway? Was your patient unstable, seizing, etc? Or was it

someone that could be " eyeballed " to be stable enough to wait a

couple of minutes while a bed is cleared or to go through the triage

process?

I've been on both sides of the equation . . . delivering and

receiving the patient in the ER. On both sides I just tried to do

my best for the patient - sometimes things don't work out textbook

perfect. When that becomes a pattern, then it's time to raise Cain

and intervene.

Just my two cents,

Jen

> > > > Now I may be missing something or perhaps simply

unaware,

> > but,

> > > > it is my understanding that in order for there to be a valid

> > > transfer

> > > > of care there must take place a face to face conversation

> > between

> > > the

> > > > medic and a person of same or higher level of care in the

> > hospital.

> > > > This serves two specific purposes. First, the relationship

> > between

> > > > the service's medical director and the patient must be

> severed.

> > > > Transfer of care to another physician by virtue of reception

> by

> > > > hospital staff will accomplish that end. By the way,

according

> > to

> > > > JCHAO an RN must do the initial assessment and discharge

> > > assessment.

> > > > So, that person, from everyones perspective, should be an

RN.

> > >

> > > What about emergency departments that staff LVNs? A

registered

> > nurse

> > > could delegate the task of initial assessment to an LVN for

> > purposes

> > > of triage which they are more than qualified to do. From that

> > point

> > > of view, I would venture to say that the EMS medical directors

> > > relationship with the patient has been severed once the LVN

has

> > > received a report from EMS personnel.

> > >

> > > > Secondly, it insures that ED staff is aware not only of the

> > > patients

> > > > presence but also of their triage catagory and relative

> > disposition

> > > > after your treatment. Unless I have misunderstood the advice

> > given

> > > > here, it has been suggested that the patient be left in the

> > hallway

> > > > without giving report to the hospital staff. Would this not

> > place

> > > the

> > > > medics in a position for abandonment issues? We have always

> > taught

> > > > that in this specific situation, as it is written in several

> > texts,

> > > > leaving a patient in the ED without a proper transfer of

care

> > may

> > > be

> > > > grounds for abandonment, a lawsuit that would include not

just

> > the

> > > > medic but the service and hospital. I'm not trying to get

> > > everyone's

> > > > feathers ruffled here. I may just be unaware of some other

> laws

> > > > pertaining to this issue that would make it OK to do this.

> > Thanks.

> > > >

> > >

> > > From what I understand of JCHAO and EMTALA, a patient who

> presents

> > to

> > > an emergency department, regardless of mode of travel taken,

> must

> > > have an appropriate screening examination and/or stabilizing

> > > treatment / transfer to a higher facility. From that point of

> > view,

> > > the EMS personnel jobs are done when the patient presents to

the

> > > emergency department, whether or not the nurses have been

given

> a

> > > report.

> > >

> > > Alfonso R. Ochoa

[Guest guest]

> I have never, EVER, advocated leaving a patient in a hospital hallway

prior

> to a face-to-face report to the receiving RN. To do that would be

rank

> abandonment. As a matter of fact, no patient should be left until

the receiving RN

> or physician's signature is obtained on the care form.

>

Playing devil's advocate for a second, say the hospital is extremely

busy and banishes you to a lonesome hallway to wait with your patient.

Lo and behold, your patient codes. Who works it? I am under the

impression that once I step foot on hospital grounds, it is the ER

staff's responsibility to do so. Although I would help out in any way

possible, of course.

Alfonso R. Ochoa

[Guest guest]

> Actually, delegation is the assigning of tasks to unlicensed

> personnel. RNs do not " delegate " to LVNs - since they are

licensed,

> but instead make assignments. Since the RN is responsible for

> assessing the need for professional nursing tasks (those that an RN

> can do but an LVN can't) before making an assignment to an LVN or

> delegating to UAP, the initial assessment by definition cannot be

> assigned to anyone other than an RN (how do you know whether

> assignment of the assessment is appropriate unless you've

> assessed?). I know - I've seen places that bend the rules, but

they

> do so at risk to their license.

>

My nursing textbooks are peppered with instances of RNs delegating

procedures to LPNs/LVNs. It is quite possible we are not using the

same term consistenly.

However, you make a valid point at the close of your post. The rules

may very well be bent according to the situation.

Alfonso R. Ochoa

[Guest guest]

> Actually, delegation is the assigning of tasks to unlicensed

> personnel. RNs do not " delegate " to LVNs - since they are

licensed,

> but instead make assignments. Since the RN is responsible for

> assessing the need for professional nursing tasks (those that an RN

> can do but an LVN can't) before making an assignment to an LVN or

> delegating to UAP, the initial assessment by definition cannot be

> assigned to anyone other than an RN (how do you know whether

> assignment of the assessment is appropriate unless you've

> assessed?). I know - I've seen places that bend the rules, but

they

> do so at risk to their license.

>

My nursing textbooks are peppered with instances of RNs delegating

procedures to LPNs/LVNs. It is quite possible we are not using the

same term consistenly.

However, you make a valid point at the close of your post. The rules

may very well be bent according to the situation.

Alfonso R. Ochoa

[Guest guest]

> Actually, delegation is the assigning of tasks to unlicensed

> personnel. RNs do not " delegate " to LVNs - since they are

licensed,

> but instead make assignments. Since the RN is responsible for

> assessing the need for professional nursing tasks (those that an RN

> can do but an LVN can't) before making an assignment to an LVN or

> delegating to UAP, the initial assessment by definition cannot be

> assigned to anyone other than an RN (how do you know whether

> assignment of the assessment is appropriate unless you've

> assessed?). I know - I've seen places that bend the rules, but

they

> do so at risk to their license.

>

My nursing textbooks are peppered with instances of RNs delegating

procedures to LPNs/LVNs. It is quite possible we are not using the

same term consistenly.

However, you make a valid point at the close of your post. The rules

may very well be bent according to the situation.

Alfonso R. Ochoa

[Guest guest]

Your nursing textbooks are not Texas specific, the Texas Nurse

Practice Act is - which defines delegation as assignment of tasks to

unlicensed assistive personnel.

About the person coding on your stretcher in the hallway . . .

betcha they find a room real quick at that point.

Jen

> > Actually, delegation is the assigning of tasks to unlicensed

> > personnel. RNs do not " delegate " to LVNs - since they are

> licensed,

> > but instead make assignments. Since the RN is responsible for

> > assessing the need for professional nursing tasks (those that an

RN

> > can do but an LVN can't) before making an assignment to an LVN

or

> > delegating to UAP, the initial assessment by definition cannot

be

> > assigned to anyone other than an RN (how do you know whether

> > assignment of the assessment is appropriate unless you've

> > assessed?). I know - I've seen places that bend the rules, but

> they

> > do so at risk to their license.

> >

>

> My nursing textbooks are peppered with instances of RNs delegating

> procedures to LPNs/LVNs. It is quite possible we are not using

the

> same term consistenly.

>

> However, you make a valid point at the close of your post. The

rules

> may very well be bent according to the situation.

>

> Alfonso R. Ochoa

[Guest guest]

By the way, my only reason to bring up the semantics is so that when

someone starts quoting delegation, they realize that those rules are

a little different for LVNs.

Here's a great question though . . . if a paramedic is licensed, and

patient assessment is taught in their curriculum and is an integral

part of their scope of practice, then why are paramedics not allowed

to work triage in the ERs? I've always been confused about that

one. Is it a JCAHO standard, or ???? My personal opinion, I'd

rather have a paramedic triage me then a RN that was floated from

med-surg to " help out " .

Jen

> > Actually, delegation is the assigning of tasks to unlicensed

> > personnel. RNs do not " delegate " to LVNs - since they are

> licensed,

> > but instead make assignments. Since the RN is responsible for

> > assessing the need for professional nursing tasks (those that an

RN

> > can do but an LVN can't) before making an assignment to an LVN

or

> > delegating to UAP, the initial assessment by definition cannot

be

> > assigned to anyone other than an RN (how do you know whether

> > assignment of the assessment is appropriate unless you've

> > assessed?). I know - I've seen places that bend the rules, but

> they

> > do so at risk to their license.

> >

>

> My nursing textbooks are peppered with instances of RNs delegating

> procedures to LPNs/LVNs. It is quite possible we are not using

the

> same term consistenly.

>

> However, you make a valid point at the close of your post. The

rules

> may very well be bent according to the situation.

>

> Alfonso R. Ochoa

[Guest guest]

By the way, my only reason to bring up the semantics is so that when

someone starts quoting delegation, they realize that those rules are

a little different for LVNs.

Here's a great question though . . . if a paramedic is licensed, and

patient assessment is taught in their curriculum and is an integral

part of their scope of practice, then why are paramedics not allowed

to work triage in the ERs? I've always been confused about that

one. Is it a JCAHO standard, or ???? My personal opinion, I'd

rather have a paramedic triage me then a RN that was floated from

med-surg to " help out " .

Jen

> > Actually, delegation is the assigning of tasks to unlicensed

> > personnel. RNs do not " delegate " to LVNs - since they are

> licensed,

> > but instead make assignments. Since the RN is responsible for

> > assessing the need for professional nursing tasks (those that an

RN

> > can do but an LVN can't) before making an assignment to an LVN

or

> > delegating to UAP, the initial assessment by definition cannot

be

> > assigned to anyone other than an RN (how do you know whether

> > assignment of the assessment is appropriate unless you've

> > assessed?). I know - I've seen places that bend the rules, but

> they

> > do so at risk to their license.

> >

>

> My nursing textbooks are peppered with instances of RNs delegating

> procedures to LPNs/LVNs. It is quite possible we are not using

the

> same term consistenly.

>

> However, you make a valid point at the close of your post. The

rules

> may very well be bent according to the situation.

>

> Alfonso R. Ochoa

[Guest guest]

By the way, my only reason to bring up the semantics is so that when

someone starts quoting delegation, they realize that those rules are

a little different for LVNs.

Here's a great question though . . . if a paramedic is licensed, and

patient assessment is taught in their curriculum and is an integral

part of their scope of practice, then why are paramedics not allowed

to work triage in the ERs? I've always been confused about that

one. Is it a JCAHO standard, or ???? My personal opinion, I'd

rather have a paramedic triage me then a RN that was floated from

med-surg to " help out " .

Jen

> > Actually, delegation is the assigning of tasks to unlicensed

> > personnel. RNs do not " delegate " to LVNs - since they are

> licensed,

> > but instead make assignments. Since the RN is responsible for

> > assessing the need for professional nursing tasks (those that an

RN

> > can do but an LVN can't) before making an assignment to an LVN

or

> > delegating to UAP, the initial assessment by definition cannot

be

> > assigned to anyone other than an RN (how do you know whether

> > assignment of the assessment is appropriate unless you've

> > assessed?). I know - I've seen places that bend the rules, but

> they

> > do so at risk to their license.

> >

>

> My nursing textbooks are peppered with instances of RNs delegating

> procedures to LPNs/LVNs. It is quite possible we are not using

the

> same term consistenly.

>

> However, you make a valid point at the close of your post. The

rules

> may very well be bent according to the situation.

>

> Alfonso R. Ochoa

[Guest guest]

OK - I'll utilize the search function. I don't always get to read

this list as closely as I might want to.

>

>

> In a message dated 7/5/2005 5:23:18 P.M. Central Daylight Time,

> texsis74@y... writes:

>

> if a paramedic is licensed

>

>

> Read some of what Gene Gandy and Dr. Bledsoe have said about the

whole

> concept of LP in Texas. As I understand it based on their

statements NO paramedics

> are TRULY " licensed " .

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@a...

> (IFW Office)

> (Cell Phone)

> (IFW Fax)

>

> " A Texan with a Jersey Attitude "

>

> The comments contained in this E-mail are the opinions of the

author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or

associated with unless I

> specifically state that I am doing so. Further this E-mail is

intended only for its

> stated recipient and may contain private and or confidential

materials

> retransmission is strictly prohibited unless placed in the public

domain by the

> original author.

>

>

>

[Guest guest]

OK - I'll utilize the search function. I don't always get to read

this list as closely as I might want to.

>

>

> In a message dated 7/5/2005 5:23:18 P.M. Central Daylight Time,

> texsis74@y... writes:

>

> if a paramedic is licensed

>

>

> Read some of what Gene Gandy and Dr. Bledsoe have said about the

whole

> concept of LP in Texas. As I understand it based on their

statements NO paramedics

> are TRULY " licensed " .

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@a...

> (IFW Office)

> (Cell Phone)

> (IFW Fax)

>

> " A Texan with a Jersey Attitude "

>

> The comments contained in this E-mail are the opinions of the

author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or

associated with unless I

> specifically state that I am doing so. Further this E-mail is

intended only for its

> stated recipient and may contain private and or confidential

materials

> retransmission is strictly prohibited unless placed in the public

domain by the

> original author.

>

>

>

[Guest guest]

OK - I'll utilize the search function. I don't always get to read

this list as closely as I might want to.

>

>

> In a message dated 7/5/2005 5:23:18 P.M. Central Daylight Time,

> texsis74@y... writes:

>

> if a paramedic is licensed

>

>

> Read some of what Gene Gandy and Dr. Bledsoe have said about the

whole

> concept of LP in Texas. As I understand it based on their

statements NO paramedics

> are TRULY " licensed " .

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@a...

> (IFW Office)

> (Cell Phone)

> (IFW Fax)

>

> " A Texan with a Jersey Attitude "

>

> The comments contained in this E-mail are the opinions of the

author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or

associated with unless I

> specifically state that I am doing so. Further this E-mail is

intended only for its

> stated recipient and may contain private and or confidential

materials

> retransmission is strictly prohibited unless placed in the public

domain by the

> original author.

>

>

>